No-BS Book Reviews--Choosing Cesarean: A Natural Birth Plan

No-BS Book Reviews: Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull

When I was informed that my baby was still breech at 38 weeks and that a cesarean section was required, I knew that I was supposed to feel angry, saddened and cheated of the chance to have a “normal” delivery; instead, I felt secure, in control and—let’s be frank—pretty relieved. Anyone who wants to know why should read Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull. In this important book, the authors make a convincing case for cesarean delivery on maternal request as a valid form of birth and as the best choice for some women.

Hull is a journalist who blogs at http://cesareandebate.blogspot.com, while Murphy is a urogynecologist (essentially, someone who spends his time propping up busted pelvic floors), and their book reflects this mixture of the medical, the personal and the political. It is a comprehensive guide for anyone considering choosing cesarean or interested in learning more about the issue, discussing not only the case for cesarean but also the practical and emotional aspects of planning and recovering from a surgical birth.

After a personal intro by the authors, Choosing Cesarean starts off with a look at the safety of panned cesarean, doing an excellent job of puncturing the sloppy science and media hysteria which has blighted popular discussion of this type of birth. Stats surrounding cesarean safety are usually based on “mixed” data which combines planned and emergency sections; if you look at the data for planned sections alone, the safety record of this birth type is generally at least as good as that of spontaneous vaginal delivery. Furthermore--and this is another important point which comes up several times in the book--an emergency cesarean is usually the result of a planned vaginal delivery. The book goes on to look at birth satisfaction, noting that satisfaction levels are high and birth trauma almost non-existent among women who choose cesareans. There is a detailed discussion of the pelvic floor and things that can go wrong in vaginal births—all the things which your Lamaze class won’t tell you (one quibble: a diagram of the pelvic floor might have come in handy here). Just a warning, but this part can make disturbing reading, and if I’m honest, I came out of this section feeling like I had dodged a bullet. 

This is followed by a discussion of cesarean rates around the world and the intensely politicized debate which surrounds cesareans. An entire chapter sets out the risks of planning a cesarean in detail; Murphy and Hull never gloss over the details of surgical birth or make it out to be a superficial or cosmetic procedure. The final section of the book focuses on the “how-to” aspects, describing the surgery itself in detail and giving advice on how to plan and recover from a surgical birth, interwoven with stories, hints and tips from real women who have had maternal request cesareans.

We all have our biases when it comes to birth and Murphy and Hull are unabashedly fans of planned cesareans; nevertheless, they are clear at all times that this is only an appropriate option for women who are suitable candidates (committed to having a small family, sure of their conception dates, and fully informed about the risks and benefits of the procedure). They also state emphatically that the fact that chosen cesarean section is a valid choice does not in any way invalidate the desire of other women for natural childbirth and VBAC. The book is well-written, well-edited and clear; in the sections on pelvic floor health in particular it does a good job of explaining some complex ideas in language any layperson can understand.

Any quibbles? Well… one objection which is invariably raised whenever the idea of maternal request cesarean comes up is “The cure for the problems of vaginal delivery (pain, trauma, pelvic floor injury) is not surgical birth, but natural childbirth. These terrible problems are basically caused by women giving birth on their backs in hospital; if we all went without drugs and squatted in labor, they wouldn’t happen.” The evidence supporting this is, well… dubious, to say the least, although there is some evidence that the use of epidural anesthesia may increase the risk of a forceps/vacuum delivery; anticipating and discussing this objection might have increased Choosing Cesarean’s persuasive power. (In my own case, feeling that I had to choose between either unmedicated labor—i.e., hours or possibly days of blinding agony—or an increased risk of an instrumental delivery and all the physical and emotional trauma which that can cause, merely increased my own desire to avoid vaginal delivery if possible… neither of these options sounded very appealing!) I’m also unsure about the book’s title “A Natural Birth Plan”; cesarean birth is certainly valid, but it isn’t natural… and there’s nothing wrong with that. “Natural” isn’t always better.

These are small quibbles about what is fundamentally an intelligent, courageous and important work. I’ve recommended it to more than one person, and my own copy is now well-thumbed. Whether you are planning a cesarean, know you will have to have a cesarean anyway, are not sure either way, or are simply interested in birth politics, you’ll find this book a terrific resource. It’s worth a read.